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Saksena S, Slee A, Saad M. Atrial resynchronization therapy in patients with atrial fibrillation and heart failure with and without systolic left ventricular dysfunction: a pilot study. J Interv Card Electrophysiol 2018; 53:9-17. [PMID: 29987682 DOI: 10.1007/s10840-018-0408-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 06/28/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND We examined the long-term (≥ 5 years) outcomes of dual-site atrial pacing (DAP) when added to background antiarrhythmic drugs (AADs) and/or ablation in patients with refractory atrial fibrillation (AF) and heart failure (HF). METHODS Seventy-three patients with HF (mean NYHA HF class of 2.5) and AF refractory to AADs and/or ablation were implanted with DAP systems to achieve biatrial electrical and mechanical resynchronization (ART) and rhythm control (RC). RESULTS Thirty-eight patients with refractory AF and HF with preserved ejection fraction (HFpEF) and 35 with reduced ejection fraction (HFrEF) were enrolled. HFpEF patients had higher left ventricular ejection fraction compared to HFrEF (53 ± 5 vs. 31 ± 10% p < 0.001). Median follow-up for survival was 9.3 years (mean 9.0 years, SE 0.63) and was similar across subgroups (p = 0.127). After DAP, 87% maintained RC with improvement in NYHA HF class (mean 1.8) at 3 years. RC was similar in HFpEF compared with HFrEF patients (89 vs. 85% respectively, p = NS) and in paroxysmal versus persistent AF (90 vs. 85% respectively, p = NS). Total survival was superior in HFpEF compared HFrEF patients (75% in HFpEF vs. 45% in HFrEF at 5 years, and 60% in HFpEF vs. 34% in HFrEF at 10 years, p = 0.036). Survival trended to be better in patients with RC than those without RC (75 vs. 54% respectively at 5 years, p = .13). CONCLUSIONS ART using DAP as add on therapy improved HF and established long-term RC in many patients with HFrEF and HFpEF with refractory AF. Long-term survival rates were superior in HFpEF than HFrEF.
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Affiliation(s)
- Sanjeev Saksena
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA. .,Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA.
| | - April Slee
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA.,Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA
| | - Marwan Saad
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059, USA.,Rutgers'- Robert Wood Johnson Medical School, Piscataway, NJ, USA
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Saksena S, Slee A. Atrial fibrillation and its pernicious role in heart failure with preserved ejection fraction: a new frontier in interventional electrophysiology. J Interv Card Electrophysiol 2018; 51:89-90. [PMID: 29480345 DOI: 10.1007/s10840-018-0341-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Sanjeev Saksena
- Rutgers' - Robert Wood Johnson Medical School, Piscataway, NJ, USA.
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059J, USA.
| | - April Slee
- Electrophysiology Research Foundation, 161 Washington Valley Road, Suite 201, Warren, NJ, 07059J, USA
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Kuklik P, Molaee P, Podziemski P, Ganesan AN, Brooks AG, Worthley SG, Sanders P. Quantitative description of the 3D regional mechanics of the left atrium using cardiac magnetic resonance imaging. Physiol Meas 2014; 35:763-75. [PMID: 24671140 DOI: 10.1088/0967-3334/35/5/763] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The left atrium (LA) plays an important role in the maintenance of hemodynamic and electrical stability of the heart. One of the conditions altering the atrial mechanical function is atrial fibrillation (AF), leading to an increased thromboembolic risk due to impaired mechanical function. Preserving the regions of the LA that contribute the greatest to atrial mechanical function during curative strategies for AF is important. The purpose of this study is to introduce a novel method of regional assessment of mechanical function of the LA. We used cardiac MRI to reconstruct the 3D geometry of the LA in nine control and nine patients with paroxysmal atrial fibrillation (PAF). Regional mechanical function of the LA in pre-defined segments of the atrium was calculated using regional ejection fraction and wall velocity. We found significantly greater mechanical function in anterior, septal and lateral segments as opposed to roof and posterior segments, as well as a significant decrease of mechanical function in the PAF group. We suggest that in order to minimize the impact of the AF treatment on global atrial mechanical function, damage related to therapeutic intervention, such as catheter ablation, in those areas should be minimized.
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Affiliation(s)
- P Kuklik
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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Rubaj A, Rucinski P, Kutarski A, Dabrowska-Kugacka A, Oleszczak K, Zimon B, Trojnar M, Zapolski T, Drozd J, Tarkowski A, Wysokinski A. Cardiac hemodynamics and proinflammatory cytokines during biatrial and right atrial appendage pacing in patients with interatrial block. J Interv Card Electrophysiol 2013; 37:147-54. [PMID: 23625090 PMCID: PMC3698432 DOI: 10.1007/s10840-013-9792-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 02/12/2013] [Indexed: 11/10/2022]
Abstract
Purpose Interatrial block (IAB) frequently coexists with sinus node disease and is considered a risk factor of left atrial dysfunction, atrial arrhythmias, and heart failure development. Conventional right atrial appendage (RAA) pacing impairs intra- and interatrial conductions and consequently prolongs P wave duration. Biatrial (BiA) pacing helps correct IAB, but its advantageous influence remains controversial. The aim of the study was to compare the effects of BiA and RAA pacing on cardiac hemodynamics and serum concentrations of inflammatory markers and neuropeptides. Methods Twenty-eight patients with IAB and preserved atrio-ventricular conduction treated with BiA pacing were studied. Standard invasive hemodynamic measurements were performed during BiA and RAA pacings. Furthermore, the influence of 1 week of BiA and RAA pacing on neuropeptides: atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) and markers of inflammation: high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and neopterin was examined. Results BiA pacing resulted in significant increase of cardiac output (CO) and reduction of pulmonary capillary wedge pressure. We demonstrated significantly lower concentrations of ANP, hs-CRP, IL-6, and neopterin after 1 week of BiA in comparison to RAA pacing. BNP levels remained unchanged. Conclusions BiA pacing in comparison to RAA pacing improves hemodynamic performance in patients with IAB and preserved atrio-ventricular conduction. BiA pacing is associated with reduction of ANP and markers of inflammation (hs-CRP, IL-6, and neopterin).
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Affiliation(s)
- Andrzej Rubaj
- Department of Cardiology, Medical University of Lublin, 8 Jaczewskiego Str, Lublin, Poland
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Chin KY, Ima-Nirwana S. Sex steroids and bone health status in men. Int J Endocrinol 2012; 2012:208719. [PMID: 23150727 PMCID: PMC3488403 DOI: 10.1155/2012/208719] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 09/27/2012] [Indexed: 11/17/2022] Open
Abstract
Male osteoporosis is a health problem which deserves more attention as nearly 30% of osteoporotic fractures happen in men aged 50 years and above. Although men do not experience an accelerated bone loss phase and testosterone deficiency is not a universal characteristic for aged men, osteoporosis due to age-related testosterone deficiency does have a negative impact on bone health status of men. Observations from epidemiological studies indicate that elderly men with higher testosterone can preserve their BMD better and thus are less prone to fracture. Observations on men with estrogen resistance or aromatase deficiency indicate that estrogen is equally important in the maintenance of bone health status. This had been validated in several epidemiological studies which found that the relationships between estrogen and bone health indices are significant and sometimes stronger than testosterone. Studies on the relationship between quantitative ultrasound and bone remodeling markers suggest that testosterone and estrogen may have differential effects on bone, but further evidence was needed. In conclusion, both testosterone and estrogen are important in the maintenance of bone health in men.
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Affiliation(s)
| | - Soelaiman Ima-Nirwana
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz, 50300 Kuala Lumpur, Malaysia
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Tsai WC, Liu YW, Huang YY, Tsai LM, Lin LJ. Decreased Mechanical Function of Left Atrium Assessed by Speckle Tracking and Tissue Doppler Echocardiography in Patients with Congestive Heart Failure. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Worley SJ, Gohn DC. Prolapsed double-canted bipolar left ventricular lead for pacing the left atrium via the coronary sinus: experience in 11 patients. Europace 2011; 14:445-8. [DOI: 10.1093/europace/eur331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Liang HY, Cheng A, Chang KC, Berger RD, Agarwal K, Eulitt P, Corretti M, Tomaselli G, Calkins H, Kass DA, Abraham TP. Influence of Atrial Function and Mechanical Synchrony on LV Hemodynamic Status in Heart Failure Patients on Resynchronization Therapy. JACC Cardiovasc Imaging 2011; 4:691-8. [DOI: 10.1016/j.jcmg.2011.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 02/16/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
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Left Atrial Function: Doppler and Strain. CURRENT CARDIOVASCULAR IMAGING REPORTS 2010. [DOI: 10.1007/s12410-010-9041-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dabrowska-Kugacka A, Lewicka-Nowak E, Rucinski P, Kozlowski D, Raczak G, Kutarski A. Single-Site Bachmann's Bundle Pacing Is Beneficial While Coronary Sinus Pacing Results in Echocardiographic Right Heart Pacemaker Syndrome in Brady-Tachycardia Patients. Circ J 2010; 74:1308-15. [DOI: 10.1253/circj.cj-09-0846] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Ewa Lewicka-Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk
| | | | - Dariusz Kozlowski
- Department of Cardiology and Electrotherapy, Medical University of Gdansk
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk
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Tsai WC, Lee CH, Lin CC, Liu YW, Huang YY, Li WT, Chen JY, Lin LJ. Association of Left Atrial Strain and Strain Rate Assessed by Speckle Tracking Echocardiography with Paroxysmal Atrial Fibrillation. Echocardiography 2009; 26:1188-94. [DOI: 10.1111/j.1540-8175.2009.00954.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Lewicka-Nowak E, Dabrowska-Kugacka A, Rucinski P, Kozlowski D, Raczak G, Kutarski A. Atrial function during different multisite atrial pacing modalities in patients with bradycardia--tachycardia syndrome. Circ J 2009; 73:2029-35. [PMID: 19749477 DOI: 10.1253/circj.cj-09-0411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multisite atrial pacing (MAP) was introduced to improve atrial electrical synchrony and prevent recurrence of atrial fibrillation (AF). METHODS AND RESULTS In the present study there were 57 patients with sinus node disease, AF recurrence and prolonged P-wave on ECG with 2 MAP modalities. In all patients 1 lead was implanted in the coronary sinus (CS) ostium area. In the right atrial appendage (RAA)+CS group (28 patients) the other atrial lead was in the RAA, and in the BB+CS group (29 patients) in the Bachmann's bundle (BB) region. Tissue Doppler was used to register the electromechanical delay (EMD) in the atrial walls and estimate the atrial contraction synchrony. Cardiac output and myocardial performance index did not differ during the 2 MAP modalities. During BB+CS, in comparison with RAA+CS pacing, the peak of the mitral atrial wave occurred earlier (P<0.01), the usual right-left atrial contraction sequence was reversed more frequently (P<0.004), all atrial EMDs except for the lateral left atrium (LA) were shorter (P<0.05), and LA synchrony was greater (P<0.001). CONCLUSIONS In patients treated with MAP, implanting 1 of the atrial leads in the BB area instead of the RAA has no influence on global cardiac hemodynamics, but does result in earlier LA contraction, and reversal of the typical right-left atrial contraction sequence, as well as providing greater LA contraction synchrony.
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Affiliation(s)
- Ewa Lewicka-Nowak
- Department of Cardiology and Electrotherapy, Medical University of Gdańsk, Gdańsk, Poland.
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DĄBROWSKA-KUGACKA ALICJA, LEWICKA-NOWAK EWA, RUCIŃSKI PIOTR, ZAGOŻDŻON PAWEŁ, RACZAK GRZEGORZ, KUTARSKI ANDRZEJ. Atrial Electromechanical Sequence and Contraction Synchrony during Single- and Multisite Atrial Pacing in Patients with Brady-Tachycardia Syndrome. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2009; 32:591-603. [DOI: 10.1111/j.1540-8159.2009.02332.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abraham TP, Dimaano VL, Liang HY. Role of Tissue Doppler and Strain Echocardiography in Current Clinical Practice. Circulation 2007; 116:2597-609. [PMID: 18040039 DOI: 10.1161/circulationaha.106.647172] [Citation(s) in RCA: 224] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
| | | | - Hsin-Yueh Liang
- From the Division of Cardiology, Johns Hopkins University, Baltimore, Md
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